CSEC DCFS Reporting Form

Check all that apply.
**Note: Homeless/unhoused option for NMD youth that are unhoused. NMD not in placement are NOT away from care/awol.

Housing Tentative Definitions 

  • Safe & Stable Housing: maintaining a lease, sublease, or occupancy agreement in their name for 90 or more consecutive days. This includes verbal and roommate agreements with relatives, parents, NREFMs, and/or partners.
  • Unstable Housing: challenges paying rent, overcrowding, moving frequently, and spending the bulk of income on housing.
  • Unsafe Housing: frequent evictions, unsafe neighborhood (afraid to leave the home), home in physical disrepair, the home requires adaptive equipment to be functionally safe, domestic violence, unsafe roommate, landlord conflicts, physical conflicts with staff, neighbors and/or housemates.
NMD Unhoused
Mental Health
Substance Use
Stability and Life Skills
Note: Left without permission is someone who is away from care and under 18 years old. For NMD clients who left, please enter 0.
Dual Status
Developmental Functioning
Expecting and Parenting
Sexual Reproductive and Sexual Health
*Family Planning Health Worker (FPHW)
Pregnancy Options Counseling Certification (POCC)*
Other Services